Provider Demographics
NPI:1205162955
Name:SONORAN DESERT PATHOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:SONORAN DESERT PATHOLOGY ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING MEMBER
Authorized Official - Phone:954-800-1000
Mailing Address - Street 1:810 S ATLANTIC BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4750
Mailing Address - Country:US
Mailing Address - Phone:954-800-1000
Mailing Address - Fax:954-800-1111
Practice Address - Street 1:810 S ATLANTIC BLVD STE A
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4750
Practice Address - Country:US
Practice Address - Phone:954-800-1000
Practice Address - Fax:954-800-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 4029207ZP0102X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty